The diagnosis of gonorrhea in a low-prevalence female population: enzyme immunoassay versus culture.

In a low-prevalence population for sexually transmitted disease, accurate methods of identifying Neisseria gonorrhoeae infections are of paramount importance. Tests with low sensitivity are of concern to each practitioner. Of no less concern, however, are the possible social and emotional consequences of a false-positive test in a family-based, rural, or military community. Several centers serving high-prevalence populations have shown that the Gonozyme Enzyme Immunoassay may provide many advantages in the rapid detection of gonococcal infection in these groups. Few studies, however, have evaluated its efficacy in low-prevalence populations. We compared the Gonozyme with Martin-Lewis culture medium in 1490 women considered at risk for infection with N gonorrhoeae at Keesler USAF Medical Center, Mississippi. Fifty-three women had culture-proved infections (3.6% disease prevalence). The sensitivity and specificity of the Gonozyme in this population were 92.4 and 97.2%, respectively. However, the predictive value of a positive test was only 55.1%, mandating culture confirmation. It appears that in a low-prevalence female population, standard culture techniques provide a more efficient and reliable means of detecting N gonorrhoeae than does the Gonozyme Enzyme Immunoassay.